REPUBLICAN PARTY OF CLARK COUNTY
MEMBERSHIP APPLICATION
_____Membership Renewal ______New Member ______Change of Address
Suggested Annual Membership Dues; January 1 through December 31
_____$15 Individual _____$25 Couple _____$25 Associate Member (non resident)
Name________________________________________________________________
Address_______________________________________________________________
City _________________________________State__________ Zip Code___________
Home Phone ______________Work Phone ______________
Email_________________________________________________________________
I affirm that I am eligible to vote in any national or state election, and believe in the objectives, purposes and principles of the Republican Party; and will preserve our Republican form of government as created under the Constitution of the United States and the Constitution of Wisconsin.
Signed_______________________________________________ Date______________
Make checks payable to:
Republican Party Clark County
Send to; P.O. Box 183, Neillsville, Wi. 54456
Count on me to help with:
_____membership _____phone calls ____ yard signs
_____mailings _____fair booth ____fund raiser
_____special events _____other ______________
Optional: State law requires that we ask your occupation and employer’s name and address, if your contributions total $100 or more in a year.
Occupation_________________Employer_______________________________
Employer’s Address__________________________________________________
Authorized and paid for by Republican Party Clark County, Sandy Luedke, Treasurer
Please contact Erin Yager with any questions or concerns. Erin Yager email: eriny441@gmail.com